Pediatric Rheumatology Online Journal → August 2003 → Health-Care Delivery → Abstract #179

EXPANDED PRACTICE ROLES IN PAEDIATRIC RHEUMATOLOGY - THE PHYSICAL THERAPY AND OCCUPATIONAL THERAPY PRACTITIONER

C. M. O'Brien,¹ K. J. Whitney-Mahoney,¹ N. Graham,² R. Schneider,¹ R. M. Laxer,¹ C. Graveline.¹

¹Departments of Rehabilitation Services and Division of Rheumatology, Hospital for Sick Children, Toronto, ON, Canada; ²Physiotherapy, Sudbury Regional Hospital, Children's Treatment Centre, Sudbury, ON, Canada

Statement of purpose: An innovative training program for the expanded role of a Physiotherapy Practitioner based on the nurse practitioner model, was successfully piloted and evaluated in 1997 at a major rheumatology referral centre. Significant modifications were made to the training program in 1999. Methods: Expansion of the training program included three trainees, one Physiotherapist and one Occupational Therapist from the referral centre and one Physiotherapist from an underserviced community. A one year academic component in the format of lectures, seminars, oral and written presentations was completed. The academic portion supervised by rheumatology staff and affiliated university faculty covered relevant immunology, radiology, pharmacology, dense connective tissue pathology, psychosocial function, nutrition and outcome measurement in pediatric rheumatology. In addition two trainees enrolled in a Rehabilitation Master of Science program. A two year clinical internship included instruction in general physical and musculoskeletal examination, laboratory and radiologic testing, and patient care planning under the direction of supervising rheumatologists. Clinical training occurred in general rheumatology and sub-speciality clinics (juvenile dermatomyositis, systemic onset juvenile arthritis, localized scleroderma). Results: The trainees were evaluated using a standardized clinical performance instrument, a comprehensive written case report and an oral examination. The Physiotherapy/Occupational therapy Practitioner role has been successfully integrated into general rheumatology and sub-speciality clinics. Conclusion: Preliminary observations indicate that the Physiotherapy and Occupational Therapy Practitioners play an important role in ambulatory care. Further evaluation of the practitioner role in terms of patient/parent satisfaction, patient outcomes, resource utilization and cost effectiveness is required.